The first metatarsophalangeal (MTP) joint is a frequently loaded joint, handling loads up to 90% of bodyweight. First MTP arthrodesis is a frequently performed procedure designed to improve pain in patients with degenerative MTP joint disease. There are a wide variety of fixation constructs for this procedure without consensus on the most effective method. The purpose of this study was to compare the biomechanical integrity of various constructs utilized for first MTP arthrodesis. A systematic review of the literature was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, CINAHL, MEDLINE, and Web of Science databases were searched from inception to 18 June 2023. Articles discussing the biomechanics of first MTP arthrodesis constructs were included. A total of 168 articles were retrieved. A total of 20 articles involving 446 cadaveric and synthetic bone constructs were included in the final review. Of the six articles comparing dorsal plating with compression screws to crossed interfragmentary screws, five found that dorsal plating had significantly higher stiffness. All three studies assessing shape-memory staples found them to be significantly less stable than crossed screws or dorsal plates alone. Both studies evaluating fully threaded screws found them to be stronger than crossed cancellous screws. Wedge resections have been shown to be 10 times stronger than standard planar or conical excision. Dorsal plating with compression screws is the gold standard for MTP arthrodesis. However, more research into newer methods such as fully threaded screws and wedge resections with an increased focus on translation to clinical outcomes is needed.

Late-stage talar avascular necrosis (AVN) results in devascularization of the talus with osteonecrosis and subchondral collapse. A combined total ankle and total talus replacement (TATTR) with hindfoot arthrodesis may be utilized for end-stage talar AVN with tibiotalar and hindfoot joint arthritis. The purpose of this study is to evaluate the short-term outcomes of combined TATTR with hindfoot arthrodesis. Patients who underwent a combined TATTR or TTR with a hindfoot arthrodesis (subtalar with or without talonavicular arthrodesis) from 2016 to 2020 were retrospectively reviewed. Patient demographics, comorbidities, and surgical data were collected. Outcomes included the Visual Analog Scale (VAS) scores, range of motion, radiographic parameters, union rates, and complications. A total of 18 patients were reviewed. Nine patients were included with an average of 19.4 months follow-up. Significant postoperative improvements were observed in VAS scores (P < .001), ankle plantarflexion (P = .04), talocalcaneal height (P = .03), and tibiotalar alignment (P = .02). All patients achieved a successful union of their subtalar and talonavicular joints arthrodesis. There was one reoperation for a persistent varus ankle deformity. This is the first study to evaluate the clinical outcomes, radiographic outcomes, and union rate in combined TATTR with hindfoot arthrodesis. The early results demonstrated significant clinical improvement with 100% hindfoot union rate and no prosthetic failure. Level of Evidence: IV

Background: Nitinol staples are increasingly used in orthopaedic surgery for arthrodesis because of their superelasticity properties, which enable sustained dynamic compression. This study evaluates and compares outcomes of isolated nitinol staple fixation vs staple plus screw fixation in midfoot and hindfoot arthrodesis. Methods: This retrospective study analyzed 101 patients (103 joints) who underwent midfoot or hindfoot arthrodesis over 10 years, with an average follow-up of 2.2 years. Primary outcomes included fusion and revision rates. Patients without postoperative CT scans were excluded from fusion analysis but contributed to complication analysis. A musculoskeletal radiologist evaluated imaging for bony union. Fusion rates between constructs were compared using an omnibus test, followed by Fisher exact test for pairwise comparisons. Analysis of variance assessed demographic differences, with Tukey test for post hoc analysis. Results: Overall joint fusion rates were identical across the staple and staple plus screw constructs (89.1% vs 89.5%, P > .99). There was no significant difference between the constructs in any region of the foot. Staple and screw fixation demonstrated significantly higher joint revision rates compared with staples alone, most often due to symptomatic hardware removal. Conclusion: In our series, nitinol staples used in isolation or alongside static screws resulted in nearly identical fusion rates across the foot. However, the addition of a static screw to a nitinol staple significantly increases the revision surgery rate and may not be recommended in younger, more active patients who may desire future hardware removal.